Two doctors in the same field have equal years of experience with similar expertise about your condition. Assume you can choose either without needing to wait longer for the other. Does it matter if one of them cares a bit more about you as a person? The answer might surprise you. After this episode you’ll know how much emotional intelligence your physicians have on top of their medical intelligence.
It’s easier to judge a doctor’s abilities over a long period of time. If an orthopedic surgeon has done a few thousand knee replacements or if a dermatologist has been seeing melanoma patients for over 30 years, you can be reasonably confident that such professionals are solid at their job. This skill isn’t obvious during a random moment in the clinic. In the exam room, however, you can see a few things. The doctor looks into your eyes without typing away on a laptop. The doctor gives bad news about a diagnosis without a soft landing. The doctor listens to your story without interrupting. You might get shamed for being unhealthy. The doctor may encourage you to be active in medical care. There are thousands more interactions showing if your doctor cares about treating a disease as well as treating you, the patient. Immediate behavior gives away much of the doctor’s emotional intelligence that a years-long body of work on paper can’t explain. What is emotional intelligence (or EI)? It depends who you ask, but in the realm of medicine, EI matters for providers acting based on controlling their emotions, having empathy for a patient when needed, and being aware of their responsibilities. Coaching in sports is a simple but comparable example. Coaches have to adjust their approach based on their players and game plan. How coaches use players and execute a strategy is skill-based. However, interactions with the players have to vary. Some players need to be yelled at to make progress while others are better left alone.
In the exam room, certain patients want to participate in their care. Other patients want to just be in and out of the clinic to follow the doctor’s instructions without a second thought. Some patients like paternalistic doctors and others want an equalized discussion. Physicians noticing these subtle preferences personalize care for their patients to a new and practical level.
Bedside manner is not a new concept in medicine. Johns Hopkins’ first medical chief, Dr. William Osler, cared about physicians managing their behavior as well as treating both disease and patients. Dr. Osler’s The Principles and Practice of Medicine, which brings up some of these subjects, was published in 1892! Dr. Osler didn’t forget about science. The evidence-based medicine we have today is due to his belief that medicine needed a rational and consistent scientific basis. These (at the time revolutionary) ideas led to his famous quip that “practice of medicine is an art based on science.” Doctors are supposed to be patient-focused and not just locked into treating a condition. No surprise there. That being said, there’s a massive difference between a clinic saying it’s patient-centered, and being patient-focused in reality. There are few moments among many revealing much about the doctor’s character and attention for you.
As a patient, ask yourself a few questions to help estimate a doctor’s emotional intelligence. Are providers being polite with you but with not their staff? If you are due for a hard diagnosis, does the doctor callously lay down the bad news or does the doctor ease into the next phase of your care with grace? If physicians make a mistake, what do they do next? Is the doctor only telling you things to do, or is there some room for collaboration? There’s another important question besides asking if the doctor has a competent treatment plan in mind. Are you being heard? You can only find these answers during and after your time at the clinic. An online search may spell out a doctor’s track record, but there’s no scouting report for situational awareness.
Emotions can be imprecise, but that didn’t stop a few Indian researchers from conducting a 2018 study in Chennai to measure emotional intelligence. A sample of medical students addressed prompts based on socio-demographic backgrounds, private versus government education, a special EI self-assessment test, and hypothetical situations a doctor may encounter at the clinic. The researchers built their own EI scale ranging from 0-160, with 160 implying that a doctor is the saint of empathy and master of emotional control. The medical students’ average grade was 107. Here’s the problem—it’s hard to screen prospective doctors for emotional intelligence because the participants being tested will report themselves as self-aware and in command of their behavior. Beyond that fact, medical exam scores weren’t compared with each student’s EI result to put the results in context.
Empathy can never make up for bad medicine. If you’re having surgery or a complicated procedure, the doctor’s skill with a scalpel and stitches matters way more than any kind of social awareness of your pain. It’s better to have a trained but mean surgeon rather than a kind but worse surgeon. Even for regular office visits, the doctor’s treatment and your response to that treatment will always be the main factor of a successful medical relationship.
This Indian study’s methods were flawed. However, the results showed (anecdotally) the most common positive and negative payoffs of solid emotional intelligence. I added a screenshot of the study’s useful framework on my Substack post which you’ll find at rushinagalla.substack.com. Emotional intelligence still matters to patients regardless of how ambiguous it may be.
Bedside manners are necessary for higher-level care, but seasoning is no replacement for a dish. Good seasoning improves a meal, but not having a main course, meaning your doctor’s lack of actual expertise, means you stay hungry or unwell.
Don’t wait for a provider to realize they need to treat you as well as your disease. Patients can prompt the doctor to care a little more about them. If the physician didn’t introduce themselves to you, ask their name and more about their overall role in the practice. Request the doctor to listen for a moment without typing on a laptop at the same time. Some patients need tough love and paternalistic advice, but it doesn’t hurt to ask for being a larger participant in your care. Make sure your expectations of care and the doctor’s expectations of treatment line up. Don’t hesitate to ask questions like you would for any typical visit, but do so to have your doctor explain a little bit about why they’re choosing a particular treatment or assessment for you. All of these prompts help your doctor adjust their care to your preferences.
Bedside manners in medicine are usually figurative, but sometimes a doctor indeed sits next to your bed. Physicians apply their knowledge and emotional intelligence anywhere, but their assistance changes if you need medical care for one day versus one week. Whether you are at the clinic for a few minutes or staying at the hospital for a few days, the next pod will tell you exactly what it means to be an inpatient and outpatient. Subscribe and stay tuned to Friendly Neighborhood Patient for all you need to know about partnerships in medicine. I’ll catch you at the next episode.
